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  Table of Contents  
CORRESPONDENCE
Year : 2012  |  Volume : 30  |  Issue : 1  |  Page : 113
 

Suppurative sialadenitis in a neonate by methicillin-resistant Staphylococcus aureus: Do we need search and kill superbug strategy?


1 Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104, India
2 Professor and Unit Head of Neonatology, Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104, India

Date of Submission08-Sep-2011
Date of Acceptance04-Dec-2011
Date of Web Publication22-Feb-2012

Correspondence Address:
C Mukhopadhyay
Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.93087

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How to cite this article:
Mukhopadhyay C, Vandana K E, Munim F, Lewis L E. Suppurative sialadenitis in a neonate by methicillin-resistant Staphylococcus aureus: Do we need search and kill superbug strategy?. Indian J Med Microbiol 2012;30:113

How to cite this URL:
Mukhopadhyay C, Vandana K E, Munim F, Lewis L E. Suppurative sialadenitis in a neonate by methicillin-resistant Staphylococcus aureus: Do we need search and kill superbug strategy?. Indian J Med Microbiol [serial online] 2012 [cited 2019 Sep 20];30:113. Available from: http://www.ijmm.org/text.asp?2012/30/1/113/93087



 ~ Dear Editor, Top


Suppurative sialadenitis is a rare disease in neonates and children. Neonatal disease is usually associated with risk factors like prematurity, congenital anomalies and prolonged orogastric feeding. [1] We report a case of suppurative sialadenitis of parotid and submandibular glands in a term healthy neonate due to methicillin-resistant Staphylococcus aureus (MRSA).

A 12-day-old male neonate was admitted with one-day history of incessant cry, swelling below the left angle of jaw and restricted movements of head. He was born at 40 weeks of gestation by lower segment caesarean section.Examination revealed 6.5 x 4 cm diffuse, erythematous swelling over the left pre-auricular region with restricted movements of head. Ultrasonography suggested inflammation of the parotid and submandibular gland. After sending pus draining from the Wharton's duct and blood for culture, empirically intravenous ampicillin and amikacin was initiated. Methicillin-resistant  S.aureus Scientific Name Search  was isolated from the pus while blood culture remained sterile. It was sensitive to cotrimoxazole, doxycycline, vancomycin, teicoplanin, rifampicin and linezolid. Treatment was now changed to syrup cotrimoxazole. Upon screening, cultures from anterior nares, axilla, groin, fingertips and throat from the baby and mother grew MRSA with similar susceptibility patterns as that from salivary gland pus.Mother's breast milk was negative for MRSA. Both were decolonized with nasal application of mupirocin ointment and triclosan bathing.Baby recovered completely after 14 days of cotrimoxazole therapy.

Though various Gram positive and Gram negative bacteria cause suppurative sialadenitis, [1],[2],[3] increasing infection rates by MRSA in the hospital and community should draw our attention for inclusion of anti-MRSA drugs as empirical therapy in treating such infections pending culture and susceptibility results in neonatal group. Screening of the infected neonates and the caregivers for carrier status, followed by decolonisation therapy would be helpful in preventing recurrences and spread of infections. Nevertheless, handwashing and infection control practices should be strictly adhered to in neonatal intensive care units. Mandatory universal MRSA screening is not warranted when the incidence of MRSA is low. [4] More evidence is needed to study effectiveness of maternal screening for MRSA during perinatal period to reduce infections in newborns.

 
 ~ References Top

1.Weibel L, Goetschel P, Meier R, Radivojevic V, Berger C. Neonatal suppurative submandibular sialadenitis. Pediatr Infect Dis J 2005;4:378-80.  Back to cited text no. 1
    
2.Spiegel R, Miron D, Sakran W, Horovitz Y. Acute neonatal suppurative parotitis: Case reports and review. Pediatr Infect Dis J 2004;23:76-8.  Back to cited text no. 2
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3.McAdams RM, Mair EA, Rajnik M. Neonatal suppurative submandibular sialadenitis: Case report and literature review. Int J Pediatr Otorhinolaryngol 2005;69:993-7.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Garcia R, Vonderheid S, McFarlin B, Djonlich M, Jang C, Maghirang J. Cost and health outcomes associated with mandatory MRSA screening in a special care nursery. Adv Neonatal Care 2011;11:200-7.  Back to cited text no. 4
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